11 Postpartum Nursing Diagnosis, Care Plans, and More

[Melissa Mills]

For new mothers, the postpartum period comes with significant changes as they adapt to their new role and heal from giving birth. Potential mental health challenges exist as hormonal changes and other factors cause postpartum depression in 6.5% to 20% of women.
Many new mothers also experience anxiety around bonding with their babies or breastfeeding. One study reported that up to 50% of mothers stop breastfeeding their infants due to insufficient milk supply.

Complications can also appear following birth, resulting in severe health concerns and even deaths. The number of maternal deaths sharply increased to 1,178 per 100,000 live births in 2021 due to COVID-19, prompting birth centers to adopt new safety measures.

As a nurse, you can have a significant impact during the postpartum period. Frequent interactions with the new mother put you in a unique position to listen to her concerns and guide her as she enters a new chapter in her life.

Your role also encompasses watching out for symptoms that could indicate physical or psychological complications to address these issues early and improve the outcome with a relevant treatment plan.

As a nurse, you can also make a difference by developing a personalized care plan that reflects each patient's unique health history. When creating a care plan and delivering holistic care, one factor to consider is any existing health disparities in outcomes related to ethnicities and social backgrounds.

1. Impaired Parenting Care Plan

Unfortunately, some parents aren't ready to provide their babies a safe and healthy environment. As a nurse, you're usually one of the first healthcare professionals who are in a position to notice difficulties with bonding.

Nursing Diagnosis

Impaired parenting

Potentially Related To

• A history of childhood abuse
• Unwanted pregnancy
• Socioeconomic challenges
• Lack of maturity
• Knowledge deficit
• Physical illness in the mother or child
• Psychological conditions of the parents

Evidenced By

• Dissociation, rejection, or aggressive behavior toward the baby
• Lack of caretaking skills
• Voicing inability to care for the child
• Inappropriate childcare arrangements or unsafe home environment

Desired Outcomes

• Parent will gain access to resources to develop the right skills and build a support network.
• Parent will learn about parenting styles and healthy bonding.
• Parent will learn about options like guardianship or adoption.
• Parent will initiate measures to create a safe and nurturing environment.

Impaired Parenting Care Plan Assessment

1. Communicate with the patient: Use active listening to understand the parents' frustrations and concerns better.
2. Identify challenges: Ask about barriers that hinder providing an environment where the child can thrive.
3. Consider psychological health: Assess to which extent depression and other health challenges play a part in feelings of inadequacy as a parent.
4. Put the child first: Assess the child's safety and consider whether to contact social services.

Impaired Parenting Care Plan Interventions

1. Teach and demonstrate: Set an example by showing how to interact and bond with the infant. Educate the parents on normal development and typical behaviors to expect from their child at different milestones to boost their confidence.
2. Communication is vital: Encourage open communication and connect parents with relevant resources to address socioeconomic challenges. Address the stigma linked to parenting expectations and asking for help.

2. Readiness for Enhanced Parenting Care Plan

Becoming a good parent takes time. Readiness for enhanced parenting refers to the will to become a better parent.

The average age at which women have their first child is 23 years old, meaning that many new mothers face economic and social challenges on their way to becoming successful parents.

Nursing Diagnosis

Readiness for enhanced parenting

Potentially Related To

• Single parenthood
• Socioeconomic challenges
• Lack of support network
• Physical or psychological health challenges
• Knowledge deficit

Evidenced By

• Anxiety regarding one's ability to care for the child
• Lack of knowledge about parenting
• Lack of concrete plans regarding supporting and caring for the child
• Verbalizing inability to care for the child

Desired Outcomes

• Parents verbalize necessary changes to create a healthy environment.
• Parents learn about resources they can use.
• Parents establish a concrete plan to reach personal or professional goals to better care for the child.

Readiness for Enhanced Parenting Care Plan Assessment

1. Assess knowledge: Communicate with the parents to better understand how much they  know about parenting skills, normal newborn behaviors, and safety measures they should take, such as how to ensure safe infant sleep.
2. Discuss the mother's feelings: Be a compassionate listener. Ask how the mother or father feels about their new role and encourage them to voice anxiety and other concerns.
3. Teach about the importance of outside help: Find out how much the parents know about the community resources available to them. Ask about other support systems, such as extended family and friends. Inquire if they feel comfortable asking others for help.

Readiness for Enhanced Parenting Interventions

1. Teach caretaking skills: Demonstrate how to care for the baby, including feeding, holding, or changing diapers. Ask the parents to provide a return demonstration to assess their knowledge and build comfort with each task. Teach the new mother to recognize feeding cues and other signs the newborn uses to communicate.
2. Help with planning for the future: Encourage open communication and questions to address anxiety. Discuss the future with the parents and encourage them to formulate a concrete plan, including community classes or resources, to keep improving their parenting skills.

3. Ineffective Breastfeeding Care Plan

The CDC reports that breastfeeding exclusively drops significantly over the first six months of life for many infants. While 83.2% of all infants start out receiving some breast milk, by six months, only 24.9% of infants receive breast milk exclusively. One explanation for this decrease in breastfeeding is that families who breastfeed lack the support systems needed to reach long-term breastfeeding goals. This research supports the need for care plan development for families who experience ineffective breastfeeding. 

Nursing Diagnosis

Ineffective breastfeeding

Potentially Related To

• Inadequate knowledge about breastfeeding techniques or its importance
• Inadequate support systems
• Ineffective suck-swallow response in the infant
• Maternal breast pain
• Insufficient breast milk production
• Maternal ambivalence to breastfeeding

Evidenced By

• Infant is unable to latch to the breast
• Infant crying or fussing within one hour of breastfeeding
• Inadequate weight gain in the infant
• Sustained weight loss in the infant
• Painful or sore nipples persisting beyond the first week of breastfeeding
• Perceived insufficient milk production
• Insufficient emptying of each breast during a breastfeeding session

Desired Outcomes

• Patient will achieve effective breastfeeding with adequate milk production.
• Patient demonstrates proper breastfeeding techniques, including positioning and latching.

Ineffective Breastfeeding Care Plan Assessment

1. Assess risks for ineffective breastfeeding: Assess for modifiable risk factors to provide adequate information and support to the mother to develop effective breastfeeding techniques. 
2. Assess patient's breastfeeding knowledge: Assess the patient's knowledge, understanding, and beliefs about breastfeeding to correct any inaccuracies or myths. 
3. Perform a breast assessment: Assess for barriers such as nipple soreness, breast engorgement, history of breast surgery, or poor enlargement of the breasts during pregnancy.
4. Assess infant's sucking reflex: It's critical to begin interventions for infant sucking issues  early to correct any problems. 

Ineffective Breastfeeding Care Plan Interventions

1. Educate the mother about breastfeeding: Provide education regarding breastfeeding techniques and encourage questions. Make sure the mother understands producing milk and getting an infant to latch on properly can take time.
2. Establish a breastfeeding plan: Refer the mother to a lactation consultant. You can also present bottle feeding as an alternative and assist with proper breastfeeding positioning.
3. Encourage skin-to-skin contact immediately after delivery. This technique promotes breastfeeding initiation and improves the mother's milk supply.
4. Promote comfort and relaxation during breastfeeding. Being uncomfortable can lead to poor let-down reflexes and the mother stopping breastfeeding too soon.

4. Infection Care Plan

Infections are a reasonably common nursing diagnosis for postpartum women since this complication affects 5% to 7% of women who give birth. It's a severe complication that significantly increases the risk of maternal death and can cause additional anxiety for the new mother.

Nursing Diagnosis

Infection care

Potentially Related To

• Trauma sustained during childbirth
• Retained placental fragments (RTF)
• Cesarean section
• Mastitis
• Evidenced By
• Pain
• Fever
• Rapid heart rate
• Localized swelling and tenderness

Desired Outcomes

• Patient is without signs or symptoms of infection. 
• Vital signs return to normal.
• Infection Care Plan Assessment

1. Perform a physical exam: Look for common signs of infection, such as swelling, tenderness, and pain at the site of the infection (breast, perineal area, abdomen). Discuss the patient's symptoms to rule out other possible causes of pain.
2. Lab work: Use blood tests to confirm the presence of infection. An elevated white blood cell count will indicate an infection. 

Infection Care Plan Interventions

1. Seek medical care: Refer the patient to a doctor immediately for further assessment and possible antibiotic therapy. 
2. Assess Surgical Incisions for signs of infection:  Keep the incision site clean and assess for signs of infection, such as odor, redness, swelling, and purulent drainage.  
3. Educate the patient: Teach the patient the signs and symptoms of infection and when to report them to the nursing staff or their healthcare provider. 

5. Risk for Pain Care Plan

A study conducted in Finland found that 83% of women giving birth for the first time used an epidural. While pain management is a crucial goal during labor and delivery, many mothers also need a pain management plan in the weeks that follow.

Nursing Diagnosis

Risk for pain

Potentially Related To

• Multiple births
• Cesarean birth
• Trauma sustained during birth
• Prolonged labor

Evidenced By

• Patient voicing pain or discomfort
• lady partsl tears
• Uterine rupture
• Nerve injury

Desired Outcomes

• Patient reports pain is 4/10 or less within 2 hours of nursing interventions.
• Patient verbalizes an improvement in pain and discomfort. 

Risk for Pain Care Plan Assessment

1. Identify the patient's risk for pain: Assess the patient's birth experience and potential for painful injuries. Communicate with the labor and delivery team regarding birth trauma or any C-section complications.
2. Listen to the patient: Assess the patient's pain levels and self-reported symptoms regularly. Using a 0-10 scale will help you track pain levels.

Risk for Pain Care Plan Interventions

1. Administer analgesics as prescribed: Providing analgesics per the physician's order helps control exacerbation of pain. Monitor for side effects and effectiveness of the intervention and report any changes or further needs to the physician. 
2. Monitor the healing process: Beyond managing pain, this nursing diagnosis for postpartum calls for monitoring the healing process closely to observe for any signs of possible complications, such as infection.
3. Utilize distraction to reduce pain: Encourage activities that help distract the mother from the pain while she is not caring for the newborn. Examples include meditation, position changes, or breathing exercises. Provide plenty of support and reassurance since recovering from a physical injury can make parenting difficult. 

6. Caregiver Role Strain Care Plan

More than 50% of Americans over 40 find themselves caring for aging parents and children. Welcoming a new addition to the family can be a source of stress that results in caregiver role strain for those who already have obligations.

Nursing Diagnosis

• Caregiver role strain
• Potentially Related To
• Acting as a caregiver to an aging or sick relative
• Acting as a caregiver to multiple children
• A history of burnout

Evidenced By

• Lack of energy
• Feelings of hopelessness
• Neglecting one's needs

Desired Outcomes

• Parent verbalizes strategies to use to improve feelings of burnout or overwhelm.
• Parent demonstrates ability to care for infant without physical or emotional side effects.
• Parent verbalizes hope and confidence in their ability to perform in their new role.

Caregiver Role Strain Care Plan Assessment

1. Learn more about the caregiver's situation: Ask the parent about their home situation and other caregiving obligations. Letting new parents open up about their anxieties and concerns can reveal they juggle many roles at home.

Caregiver Role Strain Care Plan Interventions

1. Help create realistic expectations: Discuss healthy expectations for a new parent and encourage the patient to set boundaries if they struggle with their other roles.
2. Provide support: Demonstrate proper infant caregiving skills to help the patient feel more confident about their ability to care for their newborn.

7. Fatigue Care Plan

Research shows that mothers of children under the age of two experience higher levels of fatigue, independently from the amount of sleep they get. Fatigue typically includes a lack of motivation, frequent drowsiness, and low energy levels.

Nursing Diagnosis

Fatigue

Potentially Related To

• An underlying health problem
• Undiagnosed postpartum depression
• A history of fatigue or burnout

Evidenced By

• Feelings of tiredness
• Lack of energy
• Change in mood 

Desired Outcomes

• Patient verbalizes adequate energy levels.
• Patient utilizes tools and resources to prevent fatigue as they settle into their role as a parent.

Fatigue Care Plan Assessment

1. Ask about sleep and energy: Identify new mothers at risk for fatigue by asking about their sleep schedule and overall energy levels.
2. Identify underlying causes: Assess vital signs and lab values to rule out physical causes of reported symptoms. Encourage open communication with the patient to identify potential signs of postpartum depression.

Fatigue Care Plan Interventions

1. Provide assistance: Help the patient perform tasks as needed, including caring for the newborn.
2. Treat underlying causes: Treat abnormal lab values or let the patient rest to recover after giving birth.
3. Educate the patient: Provide information about diet, exercise, or sleep hygiene to help the patient manage fatigue in the future.

8. Self-Esteem, Situational Low Care Plan

Research shows that as many as 23% of teen girls suffer from low self-esteem. For many women, these feelings persist into adulthood and can lead to a severe situational low during the transition to parenthood.

Nursing Diagnosis

Self-esteem, situational low

Potentially Related To

• Difficult childhood
• Disapproval from relatives regarding the pregnancy
• A history of depression and low self-esteem

Evidenced By

• Being overly critical of oneself
• Focusing on negative things
• Withdrawing from activities they once enjoyed
• Decreased desire to care for the newborn

Desired Outcomes

• Patient verbalizes their understanding of the self-esteem issues.
• Patient verbalizes feeling more confident about fulfilling their role as a parent.

Self-Esteem, Situational Low Care Plan Assessment

1. Assess the patient's mental state: Ask questions and encourage open communication to identify negative feelings. Listen for statements that reflect low self-esteem and feelings of doubt or hopelessness.
2. Identify whether negative feelings affect the patient's ability to care for the child: Ask the patient if they are experiencing difficulty bonding or if they lack confidence in their ability to provide care to the infant. Observe for evidence of these feelings, such as not soothing the infant when it cries. 

Self-Esteem, Situational Low Care Plan Interventions

1. Focus on the positive: Help the patient reframe the situation by highlighting their achievements. Consider asking the physician for a referral to a counselor or psychologist if ongoing support is needed.
2. Educate the patient: Discuss the adverse effects of deprecating statements. Encourage the patient to seek help to deal with their self-esteem issues.

9. Deficient Fluid Volume Care Plan

Postpartum hemorrhage, or an excessive loss of blood when giving birth, is a condition that affects 14 million women globally each year. Excessive blood loss can result in a deficient fluid volume diagnosis, a condition where the patient loses water and electrolytes.

Nursing Diagnosis

Deficient fluid volume

Potentially Related To

• Uterine atony
• Postpartum hemorrhage

Evidenced By

• Blood loss of 500ml or more
• Hypotension
• Weakness
• Dehydration
• Changes in mental status
• Tachycardia
• Decreased urine output

Desired Outcomes

• Patient maintains a blood pressure above 90/60 mm Hg.
• Patient's hemoglobin levels are within normal limits.

Deficient Fluid Volume Care Plan Assessment

1. Monitor vital signs: Postnatal hemorrhage is a leading cause of maternal death. Monitor for signs of hypotension, confusion, faintness, weakness, and tachycardia. 
2. Identify signs of dehydration: Assess the patient's degree of dehydration by looking for signs like urine concentration or loss of skin elasticity.
3. Assess the uterus: If there are signs the patient is bleeding, a thorough assessment of the uterus must be completed. Assess for a "boggy" or soft uterus, which can indicate it isn't contracting after the birth of the infant. 
4. Monitor lochia: Bleeding after delivery is expected. However, the amount of bleeding should decrease after a few hours and should not contain large clots. Watch closely for serious bleeding beyond and extended bleeding and report to the physician immediately should there be concerns.

Deficient Fluid Volume Care Plan Interventions

1. Manage postpartum bleeding: Use blood-absorbing products, uterine massage, and uterotonic agents to stop the bleeding.
2. Increase fluid intake: Drinking more fluid may be sufficient in mild cases, but administering intravenous hydration is a common treatment for this nursing diagnosis for postpartum women.
3. Replace electrolytes: Follow electrolyte replacement protocols and administer potassium and phosphorus replacement products if ordered. 
4. Continue monitoring vitals: Monitor the patient's vitals until they return to normal. Report any significant changes or concerning values to the physician. 
5. Maintain bedrest. Encourage bed rest to prevent falls, dizziness, and orthostatic hypotension. If not contraindicated, consider elevating the patient's legs to promote venous return.
6. Administer blood products. If the blood loss requires blood products, administer them per the facility's protocol.

10. Ineffective Tissue Perfusion Care Plan

Ineffective tissue perfusion is a potential complication that stems from postpartum hemorrhage. In some cases, severe blood loss results in a lack of oxygenated blood flow. Tissues and organs can die.

Nursing Diagnosis

Ineffective tissue perfusion

Potentially Related To

• Postpartum hemorrhage
• Low hemoglobin

Evidenced By

• Irregular heart rhythm
• Altered respiratory rate
• Abnormal arterial blood gasses
• Nausea
• Vomiting
• High or low blood pressure
• Elevated BUN/creatinine
• Decreased urine output
• Altered mental state
• Restlessness

Desired Outcomes

• Patient will maintain cardiopulmonary perfusion as evidenced by normal heart rate and rhythm, and the absence of shortness of breath. 
• Patient will maintain adequate peripheral perfusion as evidenced by warm skin. temperature, intact skin, strong pedal pulses, and no signs of edema.

Ineffective Tissue Perfusion Care Plan Assessment

1. Monitor vitals closely: Look for changes in heart rate and rhythm, and respirations.
2. Assess the severity of the situation: Lab work can provide insights into perfusion issues. Compare results over time to assess for changes.  
3. Obtain a complete health history: Ask the patient or their family member if they have a history of conditions that affect perfusion. This might include having a history of myocardial infarction, congestive heart failure, blood clots, vascular diseases, diabetes, or organ failure. 

Ineffective Tissue Perfusion Care Plan Interventions

1. Manage symptoms: Symptom management becomes a primary nursing action. Conduct frequent and thorough assessments to identify and report any significant changes in the patient's condition.
2. Improve blood flow: Administer vasodilators, if ordered, to open blood vessels and improve blood flow.
3. Keep monitoring vitals: Watch vitals closely for any changes. Ineffective tissue perfusion can result in a heart attack or organ failure.

11. Imbalance in Mood and Behavior Care Plan

An imbalance in mood and behavior can occur during the postpartum period. The pressure of assuming a new role can cause mood changes, but shifting hormonal levels and other physical symptoms can exacerbate these changes.

Nursing Diagnosis

Imbalance in mood and behavior

Potentially Related To

• Pain
• Undiagnosed postpartum depression
• Feelings of anxiety
• Underlying mood disorder

Evidenced By

• Change in mood 
• Withdrawal
• Extreme fatigue
• Inability to stop crying
• Increased anxiety

Desired Outcomes

• Patient returns to a stable mental state.
• Patient has a clear path forward for managing future mood changes.
• Patient recognizes the need for counseling and attends per the counselor's recommendations. 
• Patient engages in social activities.

Imbalance in Mood and Behavior Care Plan Assessment

1. Rule out physical issues: Pain and fatigue can cause highs and lows. Rule out a postpartum hemorrhage by monitoring blood pressure and other vitals. An increase in body temperature beyond the third day after giving birth can indicate an infection.
2. Gather more information: Ask the patient if they have a history of anxiety, depression, or mood disorders before having the infant. 

Imbalance in Mood and Behavior Care Plan Interventions

1. Educate the patient: Educate the patient about hormonal changes and other postpartum changes to make these symptoms easier to navigate.
2. Manage physical symptoms: Keep the patient comfortable by alleviating pain and addressing other physical symptoms.
3. Provide support: Offer plenty of reassurance by modeling good caretaking behavior and encouraging the patient to bond with the infant.
4. Connect the patient to appropriate resources: Discuss mental health and encourage the patient to seek help from their support network or community resources to treat underlying mood disorders.

FAQ

Read on to learn more about common postpartum diagnoses.

What are normal postpartum symptoms?

It's normal for women to experience lady partsl discharge, incontinence, and changes in bowel movements after giving birth. Hormonal changes can lead to mood changes, breast tenderness, and other symptoms.

What are three nursing diagnoses related to postpartum hemorrhage?

Three other nursing diagnoses you might use for a patient with postpartum hemorrhage include deficient fluid volume, risk for imbalanced fluid volume, and ineffective tissue perfusion.

Which factors put a woman at risk of experiencing postpartum complications?

A pre-existing health condition increases a new mother's risk of experiencing complications. Factors like age, weight, ethnicity and socioeconomic status can also play a role.

Additional Readings and Resources

Learn more about postpartum diagnoses and nursing plans with these resources:

• Postpartum care plan with C-section and epidural anesthesia
• Postpartum diagnosis for mother/baby couplet
• Postpartum diagnosis for mother with high fundus
• Example of a comprehensive postpartum care plan
• Postpartum plan for C-section
• Postpartum care plan with surgery and risk of decisional conflict regarding adoption
• Postpartum care plan with emergency surgery

---

References

1. https://www.ncbi.nlm.nih.gov/books/NBK519070/
2. https://www.ncbi.nlm.nih.gov/books/NBK52688/
3. https://www.gao.gov/assets/gao-23-105871.pdf
4. https://www.CDC.gov/breastfeeding/data/reportcard.htm
5. https://pubmed.ncbi.nlm.nih.gov/32809639/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086622/
7. https://www.pewresearch.org/fact-tank/2022/04/08/more-than-half-of-americans-in-their-40s-are-sandwiched-between-an-aging-parent-and-their-own-children/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296457/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914631/
10. https://www.who.int/publications/m/item/who-postpartum-haemorrhage-(pph)-summit
11. https://www.ncbi.nlm.nih.gov/books/NBK555904/

[Dramaangel621]

daytonite said:

On how to write a care plan. Then, if you still have questions I will help you as long as you follow the nursing process. The first thing I need from you is a list of the patient's abnormal data (symptoms).

Thank you for your reply! OK so I read the care plan post and yes it is helpful however I already know most of the content. I am in my second semester of school so I am still having a hard time with the signs and symptoms part...Since sometimes the patient has no abnormal findings on examination. Her psych issues I found in the chart, I myself saw no signs of these issues but this is what I observed and know of her:

-her "Boyfriend" isn't there for her and appears unimpressed with him

-holding the baby and sucking her thumb and rocking at the same time (however I don't know if this is of importance)

-doesn't go to work and receives her support from wic

-lives by herself with the kids

-group b strep positive

-desires to use contraceptives when she goes home (even after her tubal ligation)

-c-section went fine with no complications and the incision is healing well with no s/s of infection

-reports pain around her incision site and grimaced when I felt for the fundus. I asked her what her pain was and she said maybe a 1-2 on scale of 10 at that time but later when I came in she was in no pain

-complains of gas

Other than that she has no abnormal symptoms. Everything on her examination was normal as well as the bubble-he part (breasts, uterus, bowel, bladder, episiotomy, homans sign, emotional)

I did notice how she wanted to hold the baby when the adoptive parents were in the room and even fed the baby with a bottle and changed his diaper. Again... Don't know if this is of importance since its not a bad thing since the adoptive parents were fine with it.

Hope this is the information you asked for.

[Daytonite, BSN, RN]

So, these are the responses, signs and symptoms you observed in this patient:

• doesn't go to work and receives her support from WIC
  
• lives by herself with the kids
  
• Group B Strep positive
  
• desires to use contraceptives when she goes home (even after her tubal ligation)
  
• incision
  
• reports pain around her incision site and grimaced when i felt for the fundus. I asked her what her pain was and she said maybe a 1-2 on scale of 10
  
• complains of gas
  
• I did notice how she wanted to hold the baby when the adoptive parents were in the room and even fed the baby with a bottle and changed his diaper

You have to remember that this lady has had surgery and although she is a pospartum patient, she is also a surgical patient. You need to go back to your med/surg textbook and review the care of the general surgical patient because it applies here. If she had general anesthesia, you need to be watching and monitoring for signs and symptoms of complications of general anesthesia:

• breathing problems (atelectasis, hypoxia, pneumonia, pulmonary embolism)
  
• hypotension (shock, hemorrhage)
  
• thrombophlebitis in the lower extremity
  
• elevated or depressed temperature
  
• any number of problems with the incision/wound (dehiscence, evisceration, infection)
  
• fluid and electrolyte imbalances
  
• urinary retention
  
• constipation
  
• surgical pain
  
• nausea/vomiting (paralytic ileus)
  

If she had an epidural, you need to be monitoring for signs and symptoms of complications of epidural anesthesia:

• hypotension
  
• rash around the epidural injection site
  
• nausea and vomiting from the opiates administered
  
• pruritis of the face and neck caused by some epidural narcotics
  
• respiratory depression up to 24 hours after the epidural
  
• cerebrospinal fluid leakage and spinal headache from accidental dural puncture
  
• sensory problems in the lower extremities

In addition, you need to look up information about the cesarean section procedure itself. You need to be aware that the following are risks of this procedure:

• infection (what's this Group B Strep positive thing about? What was cultured and tested positive?)
  
• hemorrhage
  
• urinary tract trauma
  
• thrombophlebitis
  
• paralytic ileus
  
• atelectasis
  
• anesthesia complications

When the abdomen is cut into and the bowel is in any way disrupted or touched, peristalsis which is a continual muscular motion in the GI tract, shuts down immediately. Ileus and nausea result. It takes a little time for peristalsis to get restarted and it takes several weeks for it to return to normal. If the patient's bowel was prepped (enemas to cleanse and empty the bowel), then the now quiet and motionless bowel fills with gas because of the normal presence of bacteria in the large intestine. The first symptoms you may see are a distended abdomen and nausea. When peristalsis returns, you assess for bowel sounds, the patient passing gas and finally having the first BM. One of your patient's symptoms is that she has gas. I have no doubt that some of her pain is related to the gas building up in her colon. When, I wonder was her first BM since her surgery?

Is this lady having any problems with ambulating? You didn't say. Usually with an incision like this women are reticent to get up and move around as they normally would which would warrant a diagnosis of either Impaired Physical Mobility or Activity Intolerance depending on the symptoms they have.

If she has pain and is getting pain medications and there are comfort measures that can be done for the incisional pain, the Acute Pain applies here.

To my way of thinking, an incision warrants a diagnosis of Impaired Tissue Integrity, but not everyone agrees with that. I worked on surgical units and this diagnosis was on every surgical patient's care plan.

I found it interesting that this patient desires to use contraceptives when she goes home even though she has had a tubal ligation. That sounds bizarre to me. Unless there is something I don't know about tubals, she doesn't need contraceptives anymore. It also tells me that she needs some teaching and information about the procedure and the risk of pregnancy. That's a Knowledge Deficit, tubal ligation.

You noticed that she wanted to hold the baby when the adoptive parents were in the room, fed the baby and changed his diaper. Do you suppose she has some separation or coping issues? I was thinking that she may not be ready to give this baby up. What do you think? It's also interesting that she knows the people she's giving the baby up to--keeps a tie to the baby for her, doesn't it? Decisional Conflict or Risk for Decisional Conflict?Wouldn't be the first time a mother changed her mind and might be having second thoughts.

Beyond that, unless you want to do some "Risk for" diagnoses for some of the complications listed above. I wouldn't address any of her psych problems. They are not what she is in the hospital for. This is an OB rotation and I'm betting that your instructor is going to be much happier if you address the OB problems which she does have.

Your nursing interventions address the symptoms that support each of the nursing diagnoses.

[Dramaangel621]

Thank you for all of this wonderful information! In my classes we have not yet gotten into the nitty gritty of surgery..I have only taken Adult 1 and surgery is covered in Adult 2. But this is great information for nursing implications. In response to your question, she is not really having problems ambulating. She walked around the unit fine with no pain but just some discomfort with walking. She was eager to get out of bed though to help with the gas. However I will look up which information I would need to have that diagnosis of impaired phsyical mobility or activity intolerance. I too find the contraceptive use bazarre but maybe she wants it to control her menst. cycle and other not so appealing symptoms. And you mentioned separation or coping issues...I personally don't think there were any. She is just like any other mom who still wants to hold the baby and care for him...and with her adoption agency they actually encourage this bonding time. The adoptve parents were fine with everything she wanted to do for the baby. When I was talking with her she seemed very ready to give the baby up and seemed very happy with her choice of adoption. And I think you may have misread some information because she does not know the adoptive parents personally but has come to know them through the adoption agency process. And I am starting to agree with you on not really addressing her psych issues. However, I did notice my clinical instructors writing down all the info for patient so it might seem a little weird if I don't address the psych issues since harm to herself or her children is a priority...and priority diagnosis are what we are supposed to be writing. I think that is one of the tricky parts...picking out the most important diagnosis. It just really bothered me how she tried to commit suicide during her pregnancy so I think I may write about pospartum depression for her. That would incorporate both the OB and psych issues. I cannot seem to find however an approved diagnosis that would incorporate that. Maybe Risk for Post-Trauma syndrome? Risk for Disturbed Thought Process? Or Risk for self-directed violence? Thank you for your help!

[Daytonite, BSN, RN]

I am only going by what you posted. Of course, you saw and worked with this patient so know better what is going on with her. But, let me say a couple of things about a care olan. You want to address problems that actually exist. Don't knock yourself out trying to make problems (I'm referring to the psych issues) that didn't seem to really be an issue during her time in the hospital. Past issued and problems are just that--leave them in the past. Se's not suicidal now, so it's not a problem now, so it doesn't need to be addressed unless she made comments about suicicidal ideation or told you she had a plan to kill herself. It does sound like this lady might have some behavior issues, but who doesn't? I don't know that they are issues that you really need to address therapeutically. Treating psych behavior therapeutically involves going to psych books and looking up the protocols to treat and care planning them. It's like surgical nursing--if you haven't really been exposed to it (because it's very specialized), this isn't the time to start doing it. Her behavior from what I can tell isn't outrageous enough to land her in a psych ward. I worked med/surg for years and occasionally we would get a doozy of a psych patient with a medical condition exhibiting some full-blown psych behavior. The nursing interventions for this involved developing a specific plan of treatment that had to be strictly followed by all the staff if it was ever going to work to control the patient's behavior--that's what psych units do and they are very good at it. Inevitably, there would be staff nurses who would ignore the care plan and do their own thing and we'd be back to square one with the bad behaviors. I said earlier I would address her surgical issues (she may be playing down the pain she does have or she just may be elated the baby is out) which is not something only psych patients do and ob issues which she does have. I would look at this as an ob patient with a few psych quirks which don't need to be addressed on the care plan. The one creative thing about care planning is that you can interpret the data one way and I can interpret it another. What's most important is how are your instructors going to like your interpretation. So, keep that in mind. This is why I keep going back to the fact that this is an ob rotation, not a psych rotation.

Keep in mind that to diagnose any problem you must have evidence in the form of symptoms. If you are not finding them, and a hunch is not enough, either you are missing something in your assessment and you need to revisit what you are using as an assessment tool or the evidence just isn't there and the problem doesn't exist. There is some good assessment guidelines for all kinds of body systems, including mental health on this thread of allnurses:

Health Assessment Resources, Techniques, and Forms

[Dramaangel621]

Thank you so much for your help. I ended up doing Knowledge deficit of self-care needs r/t Post cesarean section delivery and Inadequate understanding of symptoms...didnt even mention the psych issues

[beth66335, BSN, RN]

Boy, am I glad we don't have to do care plans for OB!

[Cynthia104]

Hello everyone,

I'm writing because I desperately need help with my diagnosis. I had a post term (40 wks and one day) client who was induced with pitocin and ruptured after receiving it. I formulated the following diagnosis- Amniotomy r/t induction AMB observation of pitocin being administered . The reason why I'm having difficulties is because she was AROM due to the Pitocin does it matter if it wasn't in conjunction with the amniotic hook. Can't you induce with amniotic hook and/or the pitocin? Is this a appropriate diagnosis?

Also I used this other diagnosis for my risk related to the administration of Pitocin. I was wondering if this diagnosis was appropriate for administrating Pitocin. Risk for impaired gas exchange r/t cord compression secondary to AROM and prolapsed of the umbilical cord. Please help.

Thank you

Cynthia

[CrunchyMama, ASN, RN]

Yuck! I'm dreading doing maternity next semester!

[9livesRN, BSN, RN]

Hi Cintia, I am only a student, and I just took ob last semester so here is what I can share:

When you do a AROM the purpose is to speed up labor (I was told about 1 hour or so by some nurses) and or to check the fluid for meconium...

[9livesRN, BSN, RN]

Some complications with it:

- Increased pain - the baby's head is now pressing directly in the cervix (that is if the baby is presenting that way)

- Possible early decelerations (head pressure on the cervical area)

- Possible variable decelerations (cord compression)

- Cord prolapse as you mentioned,

- There is always the risk for hemorrhage

- And anytime that some foreign thing is entering the body there is the risk for infection.

- There is the risk for increased stress on the baby related to cord compression and compromised blood flow & oxygenated blood

[9livesRN, BSN, RN]

Now your question about hook versus pitocin:

Pitocin (oxitocin) is indicated for the initiation or improvement of uterine contractions, it can be tittered as needed, and you are not pushing the baby out, you are increasing/improving contractions (baby's are at risk for late decelerations when you increase contractions intensity/amount)

* Remember it will not dilate the woman or anything like that, will just increase contractions (look at your book and there is a table that they use based on stage and dilation that will or not qualify the woman for pitocin. I just forgot the name of the table *sigh*)

[9livesRN, BSN, RN]

Now when you go ahead and poke a arom, there is no titter that is straight up pretty much done, now of course they plan that with dilation, stage, baby position and everything else, not to have an emergency on the table.

So then.... You can play will all that info that i gave you and come up with so many combos as diagnoses.

Risk for infection r/t amniotomy etc...

Risk for hemorrhage etc..

Risk for decelerations etc...